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Reporting Information <br /> P O A11 ej ican Envit Uli11 ental NL'tl-f oik AEN Page of <br /> Client r 3440 Vincent Road, Pleasant Hill,CA 94523 <br /> Address ��X, __ REQUEST FOR ANALYSIS 1 CHAIN OF CUSTODY <br /> �4� o Phone(510)930-9090 <br /> ContactAl, FAX(510)930-0256 c� Lab Job NumberC� 3 <br /> c Lab Destination <br /> Alt Contact �'` '1�'� Date Samples Shipped <br /> Address Report To Send Invoice To - — Lab Contact <br /> Date Results Required r Z ✓ { clx <br /> 2 9 <br /> Date eport Required <br /> (or-0,40 Client Phone No i <br /> Client FAX N 14 <br /> a <br /> ANALYSIS <br /> Send Report To 1 or (Circle one) <br /> (Tient P O No pQ 1 D <br /> Client Prosect! D No <br /> -ample Team Member(s) <br /> Lab Client Sample Air Date/ Sample No Type <br /> Number Identification Volume Time Type. Pres of of <br /> Collected Cont Cont (� Comments 1 Hazards <br /> ><5 tA <br /> Relinquished b DATE TIME Receive <br /> Receive � DAT TIME <br /> (Signature) � e-(- (Sigy / - <br /> �atCe) ZR <br /> Relinquished by,/ DATE TIME Received t)y DATE TIME <br /> (Signature) (Signature) <br /> 13elmquishedby DATE TIME Received by DATE TIME <br /> (Signature) (Signature) <br /> Method of Shspment Lab Comments <br /> Sample type(Specify) 1)37mm 0 8 pm MCEF 2)25mm 0 8 pm MCEF 3)25mm 0 4 pm polycarb filter <br /> r • 4)PVC filter diam pore size 5)Charc a 6}Silica gel tube 7)Water 8)Soil 9) Bulk Sample • <br /> t 10)Other )Other <br />